<i>Corynebacterium diphtheriae</i> Native Aortic Valve Endocarditis in a Patient With Prosthetic Mitral Valve: A Rare Presentation

Pachirat, Orathai; Kaewkes, Danon; Pussadhamma, Burabha; Watt, George

doi:10.14740/cr741w

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…Today, all cardiac valves can be implanted and more than half of PVE was at the aortic valves followed by mitral valve involvement in our study. Conversely, there are preliminary data of uninfected prosthetic valves in patients with coexistent NVE [12]. We have shown that 7.4% of the NVE patients had uninfected cardiac implants.…”

Section: Discussionmentioning

confidence: 72%

Portraying infective endocarditis: results of multinational ID-IRI study

Erdem¹,

Puca

Ruch

et al. 2019

Eur J Clin Microbiol Infect Dis

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Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulasenegative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042). a Including all NVE, PVE, pacemaker, and catheter port endocarditis patients. b N indicates the denominator with any identified pathogen. c Coxiella burnetii seropositivity; anti-phase 1 IgG antibody titer ≥ 1:800 A P value of <0.05 was considered significant Eur J Clin Microbiol Infect Dis

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Section: Discussionmentioning

confidence: 72%

Portraying infective endocarditis: results of multinational ID-IRI study

Erdem¹,

Puca

Ruch

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…To our knowledge, we are the first group to emphasize this benefit of 16S rDNA valve PCR for infective endocarditis patients with skin commensals in previous blood cultures. In clinical practice, skin commensals that are repeatedly isolated in blood cultures are considered causative [ 15 , 24 ]. We were able to confirm that the majority of patients with repetitive findings of skin commensals in blood cultures, had concordant species on their valve, detected by a culture-independent method, namely valve PCR.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology

et al. 2020

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Aims Upon suspicion of infective endocarditis, the causative microorganism must be identified to optimize treatment. Blood cultures and culturing of removed valves are the mainstay of this diagnosis and should be complemented by growth-independent methods. We assessed the diagnostic benefit of examining removed endocarditis valves by broad-range bacterial PCR to detect causative bacteria in cases where culturing was not available, negative, or inconclusive because a skin commensal was detected, in patients from our clinical routine practice. Methods and results Patients from Heidelberg University Hospital with suspicion of endocarditis, followed by valve replacement and analysis by 16S rDNA PCR, between 2015 and 2018, were evaluated. 146 patients with definite infective endocarditis, confirmed by the valve macroscopics and/or histology, were included. Valve PCRs were compared to corresponding blood and valve culture results. Overall, valve PCR yielded an additional diagnostic benefit in 34 of 146 cases (23%) and was found to be more sensitive than valve culture. In 19 of 38 patients with both negative blood and valve cultures, valve PCR was the only method rendering a pathogen. In 23 patients with positive blood cultures detecting skin commensals, 4 patients showed discordant valve PCR results, detecting a more plausible pathogen, and in 11 of 23 cases, valve PCR confirmed commensals in blood culture as true pathogens. Only the remaining 8 patients had negative valve PCRs. Conclusion Valve PCR was found to be a valuable diagnostic tool in surgical endocarditis cases with negative blood cultures or positive blood cultures of unknown significance. Trial registration S-440/2017 on 28.08.2017 retrospectively registered. Graphic abstract Subdividing of all infective endocarditis patients in this study, showing that valve PCR yields valuable information for patients with skin commensals in blood cultures, which were either confirmed by the same detection in valve PCR or refuted by the detection of a different and typical pathogen in valve PCR. Additionally, benefit was determined in patients with negative or not available blood cultures and only positive detection in valve PCR. +: Positive; −: negative; n/a: not available results

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“…Susceptibility testing of C. diphtheriae is not always performed, but studies report a penicillin MIC90 of 0.23 mg/l, well below the cut-off for susceptible [15]. A combination of antibiotics therapy, β-lactam, and aminoglycoside antibiotics is usually described for 4-6 weeks [3]. In our case, blood became sterile after completing 25 days of combined antibiotic therapy without any surgical interventions.…”

Section: Discussionmentioning

confidence: 68%

The Resurgence of Corynebacterium Diphtheriae: A Rare Case of Infective Endocarditis

Ardra¹,

Valsan²,

Sathiavathy³

2020

IJCR

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orynebacterium diphtheriae is well known as an agent of localized respiratory tract disease potentially complicated by systemic effects of exotoxin. The non-toxigenic strains can produce atypical manifestations of the disease as they are able to cause diseases such as mild diphtheria-like pharyngitis, cutaneous infections, septic arthritis, abscesses, septicemia, and infective endocarditis (IE) [1]. IE is a grave disease with a high incidence of complications and adverse events. IE caused due to the non-toxigenic strain of C. diphtheriae is uncommon. However, there have been increasing numbers of reports of IE being caused by this organism [2]. The current vaccine against diphtheria contains the toxoid, so it protects only against the toxigenicity but not the invasiveness of C. diphtheriae. 1 Most of the patients with C. diphtheria endocarditis have underlying cardiac diseases, especially prosthetic heart valves [3]. Pathogenic mechanisms of non-toxigenic C. diphtheriae is not well known, and a possible mechanism may be related to an increased ability to adhere to vascular endothelium. It is a universally fatal disease if left untreated with nearly 100% mortality. CASE REPORT A 34-year-old prosthetic valve in situ male patient who underwent double valve replacement surgery in 2005 presented to our hospital with a 1-week history of high-grade fever with rigor and chills. He woke up 1 day noticing that the entire visual field (both eyes) was obscured. This prompted him to come to the emergency department. No other non-visual neurologic symptoms were present. He was a chronic alcoholic and was on oral anticoagulants. On general examination, he was conscious and alert. His temperature was 100.5°F, blood pressure 140/80 mmHg, and pulse rate 80/min. Ophthalmic examination revealed only light perception with both eyes and apparently normal fundus. Investigations revealed that the total leukocyte count was elevated with neutrophil predominance, and erythrocyte sedimentation rate was also elevated. To rule out the acute cerebrovascular accident, plain axial computed tomogram head was done, which could not detect any intracranial pathology. Echocardiography showed normally functioning valves and small particles in the left ventricular outflow tract and the left ventricle. Suspecting prosthetic valve endocarditis (PVE) for the patient, three blood culture samples were taken and sent to our laboratory. Two samples were taken on the 2 nd day of admission and the third sample on the following day after starting the empirical antibiotics. The patient's vision got restored on the 2 nd day of admission to the hospital without any interventions. The blood culture samples were incubated in an automated BacT/ALERT (bioMerieux) blood culture system. After 24 h of incubation, the two samples, which were taken on the 2 nd day, flagged positive and Gram staining showed Gram-positive bacilli ABSTRACT Corynebacterium species or "diphtheroids" are often considered as non-pathogenic components of the normal skin flora when isolated from blo...

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Corynebacterium diphtheriae Native Aortic Valve Endocarditis in a Patient With Prosthetic Mitral Valve: A Rare Presentation

Cited by 10 publications

References 17 publications

Portraying infective endocarditis: results of multinational ID-IRI study

Portraying infective endocarditis: results of multinational ID-IRI study

The diagnostic benefit of 16S rDNA PCR examination of infective endocarditis heart valves: a cohort study of 146 surgical cases confirmed by histopathology

The Resurgence of Corynebacterium Diphtheriae: A Rare Case of Infective Endocarditis

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